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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518531
Report Date: 01/18/2023
Date Signed: 01/18/2023 01:29:24 PM


Document Has Been Signed on 01/18/2023 01:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:NAVARRETE, GLORIA L.FACILITY NUMBER:
410518531
ADMINISTRATOR:NAVARRETE, GLORIA L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 873-6956
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:12CENSUS: 4DATE:
01/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Gaudiosa PascualTIME COMPLETED:
01:44 PM
NARRATIVE
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On 1/18/2023, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to the Gloria Navarrette’s day-care facility. The LPA was granted entry by the Licensee’s Assistant, Gaudiosa Pascual. The LPA explained the purpose of the visit to the licensee’s assistant. According to the licensee’s assistant, the licensee is currently on vacation. Guardian, the department's system for conducting background checks, has not confirmed that all the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. During the visit, the LPA discovered that a resident of the house had not been issued a fingerprint clearance. The LPA observed the licensee’s assistant supervising four preschool children. Children's capacity and ratio requirements were observed to be in compliance.

The LPA and the licensee’s assistant both performed careful inspections of the day-care facilities to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the day-care. The building has sufficient lighting and ventilation, and it is free of any defects or conditions that could put the children in its care in risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The day-care facility is equipped with a smoke detector, a carbon monoxide detector, and a fire extinguisher that is always ready for use. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of their reach. The LPA did not find any walkers, bouncers, or other comparable objects during its inspection.

There are reportedly no firearms or other weapons on the premises, as stated by the licensee’s assistant.

The LPA found that the facility did not have any pools, spas, or other types of bodies of water of any kind.

The LPA observed that the facility had posted all the required forms, including the facility license, Notification


***See Page 2 for continuation***
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5


Document Has Been Signed on 01/18/2023 01:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: NAVARRETE, GLORIA L.
FACILITY NUMBER: 410518531

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to children in care.
POC Due Date: 01/19/2023
Plan of Correction
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The unfingerprinted individual must provide a livescan receipt to the department by the above due date
Type A
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2023
Plan of Correction
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The licensee's assistant must provide proof of CPR / First Aid course registration to the department by the above due date
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/18/2023 01:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: NAVARRETE, GLORIA L.
FACILITY NUMBER: 410518531

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(a)
Operation of A Family Child Care Home
(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 01/19/2023
Plan of Correction
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Licensee's assistant must provide proof of CPR / First Aid course registration.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 02/01/2023
Plan of Correction
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The licensee's assistant must provide proof that she has received the MMR and TDAP vaccinations.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NAVARRETE, GLORIA L.
FACILITY NUMBER: 410518531
VISIT DATE: 01/18/2023
NARRATIVE
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of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The licensee is aware that smoking is not permitted in a family childcare facility.

The LPA reviewed the records of four children. Only three out of the four children had all the required documents in their file.

The LPA reviewed the records of the assistant. Review of the assistant’s training records shows that she is not certified in Pediatric First Aid and CPR. Review of the assistant’s vaccination record shows that she did not receive the required vaccinations, MMR and TDAP

According to the licensee’s assistant, the facility satisfies the requirements by carrying out simulations of fire and earthquake drills twice a year, as well as by documenting their results.

The following reminders were discussed with the licensee’s assistant:


1. All adults 18 and over living or working in a licensed childcare facility, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed childcare facility.
2. Incidental Medical Services (IMS) policy
3. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

The following Type A violations were cited:

1. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department

2. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

The following Type B violations were cited:

1. The licensee shall be present in the home and shall ensure that children in care are supervised at all

*** See Page 3 for continuation***

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NAVARRETE, GLORIA L.
FACILITY NUMBER: 410518531
VISIT DATE: 01/18/2023
NARRATIVE
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times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

2. Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

The LPA informed the licensee’s assistant to provide a copy of this licensing report dated 1/18/2023 that documents any Type A citations to the parents or guardians of all children currently enrolled by the next business day or the next day the children are in care, and to the parents or guardians of any newly enrolled children for a period of 12 months from the date of this report. The deadline for providing this information is the next day the children are in care. For the purposes of verification, the child's file needs to have either a signed Acknowledgement of Receipt of Licensing Report (LIC 9224) or another type of written statement.

A copy of this report, and the “Notice of Site Visit”, and their appeal rights were given to the licensee’s assistant

A “Notice of Site Visit” and the Type A violations must remain posted for 30 days..

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with the Licensee’s Assistant, Gaudiosa Pascual

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
LIC809 (FAS) - (06/04)
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